Self-Reflection Worksheet

Take a few moments to honestly reflect on your current thoughts, feelings, and triggers. Write your responses in the spaces provided.

1. What thoughts have been on your mind today?

2. Which emotions are you experiencing right now? (For example: sadness, anger, anxiety, relief, etc.)

3. On a scale of 1 (calm) to 10 (overwhelmed), how would you rate your current emotional state?

Use the Emotion Thermometer Scale to guide you.

Rating: ____

4. Identify any situations, people, or events that tend to trigger distressing thoughts or feelings for you.

5. When you notice these thoughts or feelings coming up, what do you usually do to cope? Have these strategies been helpful?

6. What do you hope to gain from today’s session?

When you’re finished, we’ll use your responses to guide our conversation and explore healthy coping strategies together.

Emotion Thermometer Scale

Use this scale to rate your current emotional intensity. Circle the number that best describes how you feel right now.

After selecting your number, use it to help describe your feelings during our conversation.

My Rating: ____

Coping Strategies Cards

Below is a set of evidence-based coping strategies. Review the cards and choose three you’d like to try today. For each strategy you select, write a brief note on how you might use it when feeling distressed.

1. Deep Breathing
• Inhale slowly for 4 counts.
• Hold your breath for 2 counts.
• Exhale gently for 6 counts.
• Repeat 5 times.

Notes:

2. 5-4-3-2-1 Grounding
• Name 5 things you can see.
• Name 4 things you can touch.
• Name 3 things you can hear.
• Name 2 things you can smell.
• Name 1 thing you can taste.

Notes:

3. Progressive Muscle Relaxation
• Tense each muscle group (toes → head) for 5 seconds.
• Slowly release tension and notice the difference.

Notes:

4. Journaling
• Write freely for 5 minutes about what you’re feeling.
• Don’t worry about spelling or grammar—just express yourself.

Notes:

5. Physical Movement
• Do 1 minute of jumping jacks, stretch, or take a short walk.
• Focus on how your body feels as you move.

Notes:

6. Creative Expression
• Draw, doodle, or color to reflect your current emotions.
• Use shapes, patterns, or colors—there’s no right or wrong.

Notes:

7. Positive Self-Talk
• Write or say aloud three affirmations (e.g., “I am strong,” “I deserve kindness”).
• Repeat them until you feel more grounded.

Notes:

8. Music Break
• Choose a song or playlist that calms or uplifts you.
• Listen mindfully—notice the melody, lyrics, and rhythm.

Notes:

9. Sensory Soothing
• Hold a comforting object (e.g., soft fabric, stress ball).
• Sip a warm drink or use a scented item (e.g., lavender).

Notes:

10. Reach Out
• Send a text or call a trusted friend, family member, or counselor.
• Share a bit about how you’re feeling—connection can help.

Notes:

After you’ve selected your three strategies, we’ll discuss which one you’d like to practice together today.

Safety Plan Template

Use this template to create a personalized plan for moments of distress. Fill in each section with details that feel right for you. We’ll review this together to ensure you know how to use it when you need it most.

1. My Warning Signs

Thoughts, feelings, situations, or behaviors that let me know I’m in crisis.

2. Internal Coping Strategies

Coping tools I can do on my own (see Coping Strategies Cards for ideas).

3. Distraction Activities and Safe Places

Places I can go or activities I can try to take my mind off distress.

4. People and Social Supports

Names and contact info for friends, family members, or peers I trust.

5. Professional Resources and Helplines

Counselor, therapist, crisis lines, or emergency contacts.

• _________________________________: _________

• _________________________________: _________

• _________________________________: _________

6. Making My Environment Safer

Steps I can take to remove or secure objects or situations that increase risk.

7. Reasons to Keep Going

Personal motivations, goals, or hopes that remind me why life is important.

When you’ve completed your plan, keep it somewhere you can access easily—on your phone, in your notebook, or posted in a safe place. Reach out to your supports or crisis resources whenever you need help using it.

Healing Inner Strength Script

Use this word-for-word guide to lead a confidential, one-on-one 30-minute session. Speak slowly, kindly, and allow pauses for the student to reflect and respond. Have all materials ready: Self-Reflection Worksheet, Emotion Thermometer Scale, Coping Strategies Cards, Safety Plan Template, notebook, and pen.

1. Establish Rapport and Check-In (5 minutes)

Teacher: “Hi [Student Name], I’m really glad we have this time together today. Before we begin, I want to remind you that everything we talk about is confidential. That means I share nothing without your permission, unless I become concerned about your safety. My goal is to support you and make sure you feel heard and safe. How does that sound to you?”
[Pause and wait for response]

Teacher: “Thank you. To get started, please look at the Self-Reflection Worksheet. On the first question it asks, ‘What’s on your mind today?’ Go ahead and take as much time as you need to write or share out loud.”
[Allow student to write or speak]

Teacher: “I appreciate you sharing that with me. Next, let’s check in on how you’re feeling right now. Please use the Emotion Thermometer Scale to pick a number between 1 and 10.”
[Pause while student selects]

Teacher: “What number did you choose, and what does that number mean for how you’re feeling in this moment?”
[Listen and validate: “That makes sense—feeling an 8 can feel overwhelming. Thank you for telling me.”]

2. Explore Self-Harm Thoughts (5 minutes)

Teacher: “Sometimes when strong feelings come up, people may experience thoughts of hurting themselves. Have you had any of those thoughts recently?”
[Pause; allow student to respond]

Teacher: “I’m so proud of you for talking about that. It takes a lot of courage. Can you tell me what kinds of situations or feelings tend to trigger those thoughts for you?”
[Encourage detail; follow up with gentle probes:]
– “What tends to happen right before you feel that urge?”
– “How do you notice it in your body or mind?”

Teacher: “Thank you for sharing those warning signs. Noticing them is the first big step in staying safe.”

3. Introduce Self-Compassion and Coping Strategies (10 minutes)

Teacher: “I want to introduce a concept called self-compassion—treating yourself with the same kindness and understanding you’d offer a close friend. When you’re in distress, self-compassion can help soften difficult feelings.”

Teacher: “Here are the Coping Strategies Cards. Please look through and choose three strategies that feel doable and helpful to you today. Take a moment to pick your cards.”
[Pause while student selects three]

Teacher: “Great choices. You selected:

Which one would you like to try together right now?”
[Assume student picks “Deep Breathing.”]

Teacher: “Let’s practice deep breathing. I’ll guide us through five rounds. Ready? Inhale slowly for 4…2…3…4. Hold for 2…1…2. Exhale gently for 6…2…3…4…5…6. That’s one. Let’s do four more.”
[Guide breathing; after finishing:]
Teacher: “How did that feel?”
[Validate: “It’s normal if it felt odd at first. With practice, it often becomes more calming.”]

4. Develop Safety Plan (5 minutes)

Teacher: “Now we’ll create a personalized safety plan you can use when things feel overwhelming. Please open the Safety Plan Template.”

Teacher: “Section 1 asks for your warning signs—those thoughts, feelings, or situations that signal you might be at risk. Based on what we discussed, what would you list here?”
[Write student’s input together]

Teacher: “Section 2 is internal coping strategies—things you can do on your own. Which of the coping cards might fit here?”
[Student answers; teacher writes]

Teacher: “Section 3 is distraction activities or safe places. Where could you go, or what could you do, to shift focus when you notice those warning signs?”
[Gather ideas and note them]

Teacher: “Section 4 lists people you can reach out to—friends, family members, or peers. Who do you trust and feel comfortable calling or texting?”
[Add contacts]

Teacher: “Finally, Section 5 is professional resources and helplines. You can always call your counselor or emergency services if you’re in immediate danger. Let me read you a few important numbers...”
[List hotlines]

Teacher: “This plan is yours. Keep it somewhere you can access easily—your phone, your notebook, or posted in a safe spot.”

5. Closing and Next Steps (5 minutes)

Teacher: “You’ve done essential work today. Let’s briefly review your safety plan and the coping strategies you practiced.”
[List key points aloud]

Teacher: “Do you feel comfortable using this plan if you ever notice those warning signs?”
[Address any questions]

Teacher: “I’d like to schedule a quick follow-up next week to see how you’re doing. Would [Day/Time] work for you?”
[Confirm appointment]

Teacher: “Thank you so much for your openness and bravery today. Remember, you’re not alone and you deserve support and kindness—from yourself and others. If you ever need to talk before our next meeting, please reach out to [Trusted Contact] or one of the crisis lines we listed.”

Teacher: “Take care, and I’ll see you soon.”

You have now guided the student through emotional check-in, exploration of self-harm thoughts, self-compassion practice, coping skill rehearsal, and safety planning—all within 30 minutes. Keep your tone warm, patient, and nonjudgmental throughout.

Session Reflection Exit

After our session today, please take a few moments to reflect on your experience and plan for next steps. Write your honest responses below.

1. On a scale of 1 (not at all) to 10 (completely), how safe do you feel right now?

2. Which coping strategy from the Coping Strategies Cards do you think will help you most?

3. What is one thing you will do the next time you notice your warning signs (from your Safety Plan Template)?

4. Who is one person you could reach out to if you felt distressed before our next meeting?

5. What is one key takeaway or practice from today’s session that you want to remember?

Thank you for your honest reflections. Keep this exit ticket with your safety plan and review it whenever you need a reminder of your coping steps and supports.